Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Clin Gastroenterol Hepatol. 2019 May;17(6):1201-1203. doi: 10.1016/j.cgh.2018.08.016. Epub 2018 Aug 10.
The differential diagnosis of an increase in alanine aminotransferase (ALT) level and/or aspartate aminotransferase (AST) level of ≥1000 IU/L often is stated to include 3 main etiologies: ischemic hepatitis, acute viral hepatitis (typically hepatitis A and hepatitis B), and drug-induced (more specifically, acetaminophen/paracetamol) liver injury (DILI). Unfortunately, there are a paucity of studies examining the most common causes of acute liver injury (ALI) and those that have been published have been small, single-center, or examined less severe increases in ALT or AST levels. We conducted a multicenter study of all patients with an ALT and/or AST level ≥1000 IU/L. Our study had 3 main goals: (1) to determine the most common causes of an ALT and/or AST level ≥1000 IU/L, along with their relative frequencies; (2) to determine differences in etiology based on hospital type (liver transplant center, community hospital, Veterans Affairs hospital); and (3) to confirm or disprove the differential heuristic that ischemic hepatitis, acute viral hepatitis, and acetaminophen toxicity are the most common etiologies.
血清丙氨酸氨基转移酶（ALT）和（或）天冬氨酸氨基转移酶（AST）水平升高至≥1000IU/L 的鉴别诊断通常包括 3 种主要病因：缺血性肝炎、急性病毒性肝炎（通常为甲型肝炎和乙型肝炎）和药物性肝损伤（更具体地说，是乙酰氨基酚/扑热息痛）。然而，很少有研究探讨急性肝损伤（ALI）最常见的病因，而且已发表的研究规模较小，属于单中心研究，或者检查的是 ALT 或 AST 水平较轻度升高。我们进行了一项针对所有 ALT 和/或 AST 水平≥1000IU/L 的患者的多中心研究。本研究有 3 个主要目标：（1）确定 ALT 和/或 AST 水平升高至≥1000IU/L 的最常见病因，及其相对频率；（2）根据医院类型（肝移植中心、社区医院、退伍军人事务医院）确定病因差异；（3）证实或推翻缺血性肝炎、急性病毒性肝炎和乙酰氨基酚毒性是最常见病因的鉴别诊断假说。
